Young kids can now get the COVID vaccine. Will schools require it?

Pfizer’s COVID vaccine is now available for kids. Will schools require it?

Pfizer-BioNTech’s COVID-19 vaccine is authorized for children ages 5 to 11, and shot clinics have started. The next question, for many parents: Will their kids be required to get the shots to attend school?

The company’s vaccine cleared another hurdle Tuesday, with the Centers for Disease Control and Prevention authorizing its emergency use for kids in that age group. That means all schoolchildren are now eligible for vaccination against COVID-19. Pfizer’s vaccine is fully approved for people 16 and up, and it already was authorized for emergency use in 12- to 15-year-olds.

Vaccination likely will remain optional for the vast majority of K-12 students, experts say, at least until the shots are fully approved for children by the Food and Drug Administration.

“There’s no precedent” for requiring vaccines that are only authorized for emergency use, said Hemi Tewarson, the executive director of the National Academy for State Health Policy. “Given the questions swirling around – ‘Is it safe for my child?’ – I do think states are going to be cautious and not require the vaccine.”

Seventeen states have passed laws or issued directives banning schools or colleges from requiring students to be vaccinated against COVID-19, according to the NASHP. Some of the laws only apply to vaccines under emergency authorization, though others do not.

Where students are required to get the shots
Still, especially in states without such bans, “I would expect to see increasing movement toward adding COVID-19 to the list of vaccinations for older schoolchildren,” said Lynn Silver, a pediatrician and senior advisor at the Public Health Institute. “The question is how quickly to move forward for 5- to 11-year-olds.”

Many colleges require their students to be vaccinated against COVID-19, with some going as far as disenrolling those who refuse to comply. Meanwhile, the states of Washington and Oregon, along with dozens of districts – including 43 large, urban school systems – have in some form required teachers and staff to get the vaccine, according to the Center on Reinventing Education. In most cases, employees have the option of regular testing as an alternative.

Even before the CDC’s latest approval, a small but growing number of districts had already begun requiring vaccination for students – either for special groups or, in some cases, for every child old enough.

A handful of school systems across a dozen or so states have made COVID-19 a prerequisite for participation in sports and extracurriculars. Those include including Hawaii schools, Baltimore County Public Schools in Maryland and Warren County Schools in North Carolina.

Puerto Rico’s health department in July issued an administrative order requiring all eligible students to show proof they’d received at least one shot before returning to school after summer break.

In California, Gov. Gavin Newsom announced in October that the COVID vaccine would be added to the list of immunizations required to attend the state’s schools once it’s fully approved for all kids in a “grade span.” The mandate is expected to go into effect in July 2022 for grades 7-12.

A handful of local school districts in the state have already made it a requirement, and at least two – Los Angeles and San Diego – are being challenged in court.

Tens of millions of kid-size doses are slated for distribution, containing a third of the amount given to adults, and some places have already begun vaccinating young children. Various school systems have announced they will aid in the effort. Beginning Monday, New York City will begin hosting vaccine clinics at each of its schools. Chicago is also rolling the vaccine out at school-based clinics, as are districts across Colorado.

The CDC’s approval “is a critical next step for us to vaccinate as many of our nation’s youth – to try to help our elementary schools get back to a new normal,” said Chad Gestson, the superintendent of Phoenix Union High School District in Arizona. Maricopa County has extremely high transmission rates, and that’s been the case for much of the pandemic. Many of Phoenix’s students live in multigenerational households, which exacerbates the risk levels.

Arizona was one of the states that banned student COVID-19 vaccination mandates. Just this week, however, the state’s Supreme Court upheld a ruling blocking that and other bans. Gestson said his district will start considering whether to mandate the shot for all students in the next few months. Currently, the district requires athletes and other extracurricular participants to get the shots or undergo weekly testing.

For now, he said, “it’s about providing easy access and bringing the vaccines to the community.” This weekend, the district will be hosting several large vaccination events. It’s already seen some success with two incentive programs to get staff and students vaccinated. Today, Gestson said, 83% of its employees have had their shots, as have more than a third of students.

The role of vaccine mandates
Thus far, major organizations such as the American Academy of Pediatrics have refrained from recommending schools mandate the vaccine for children.

Mandating vaccination against COVID-19 is tricky. The vaccines have been highly politicized, and some Americans remain concerned about their safety – particularly under emergency use authorization.

In a Kaiser Family Fund survey conducted in October, shortly before the recent announcement, just 27% of parents said they will vaccinate their 5- to 11-year-old “right away” once the vaccine is authorized for that age group. Thirty percent of the respondents said “definitely not,” and 5% said they will only if their school requires it.

Unvaccinated children are much less likely than even vaccinated adults to die from COVID-19. But pediatric cases have surged since the onslaught of the delta variant, and the disease can cause severe illness and even death in children. States with higher vaccination rates in kids tended to see fewer pediatric hospitalizations after schools opened, a recent USA TODAY analysis showed.

It can also have crippling, long-term consequences for some kids, symptoms that have continued to puzzle doctors.

The benefits of vaccination requirements extend beyond children’s health, experts stressed. The more people who are vaccinated, the less likely it is that new variants will form. Higher vaccination rates boost the economy, too, allowing parents to return to work.

“For schools to be safe, to ensure continuity in education, … requiring vaccines as soon as possible will be a key step,” Silver said. Learning has been disrupted by outbreaks and quarantines, and principals find themselves serving as contact tracers. “We don’t want schools to have to be public health agencies; we want them to focus on what they do best, which is student learning.”

Vaccine mandates could also eventually mean students and staff no longer need to mask up. The role of mitigation measures such as mask-wearing varies depending on factors such as local transmission levels and vaccination rates.

“If more people get vaccinated, there’ll be less and less chance … to remain at a substantial or high transmission,” Tewarson said. “And then, by extrapolation, we’re going to get to a place where we don’t have to wear masks. So it’s all connected.”

Data out of Puerto Rico suggest student COVID vaccine mandates help to stymie community transmission. Roughly 9 in 10 eligible children in Puerto Rico are vaccinated against COVID-19, as are 98% of its school staff – well surpassing the rest of the country. Infection rates have remained relatively low on the island even during the delta surge.

Five vaccines are typically required for children to attend school in all states, including those for measles, polio and chickenpox. Such requirements are credited with enabling herd immunity and eradicating several diseases.

“We forget how devastating those diseases can be. If you’ve never seen it, it’s never a concern to you,” said Brittany Kmush, an assistant professor of public health at Syracuse University who specializes in vaccines and infectious diseases. “Having these mandates are really helpful to keep vaccination rates high and prevent any introduction of those cases into a community or into a school.”

After a wave of measles outbreaks in California – caused largely by children whose immunization requirement had been waived – the state strengthened its law and removed the “personal belief” exemption. The number of unvaccinated kindergartners, according to Silver, fell by nearly half.